Palliative Care FAQs

By Kindred Healthcare

Your Questions about Palliative Care Answered by:

Marc Rothman, MD
Chief Medical Officer, Nursing Center Division
Kindred Healthcare

And

Susan Sender, RN
Chief Clinical Officer, Kindred at Home
Kindred Healthcare

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Palliative Care FAQs What is palliative care?

Palliative care is interdisciplinary care that seeks to improve quality of life and relieve suffering for those with advanced diseases.

Where is palliative care delivered?

  • Typically in hospitals: as a specialty consult service, just like cardiology but with a palliative care physician/nurse practitioner/team instead
  • In skilled nursing facilities: either as a consult or delivered by the attending physician or primary care provider his/herself
  • At home: as a consult delivered by a nurse practitioner or physician. Sometimes palliative care is integrated into a home-health agency service line, like hospice
  • Less frequently in outpatient clinics, but some oncology and other types of practices have begun incorporating it as part of their chronic disease management programs

What is needed for a patient to receive palliative care?

A physician order for referral to/for palliative care.

Who typically delivers palliative care and how is it reimbursed?

Palliative care is reimbursed as a medical service – like seeing a primary care provider or a specialist – and payment goes to the practitioner who provides it, such as a nurse practitioner or physician. A claim is submitted for the visit, just like in the outpatient or inpatient setting, with a code for palliative care. Most palliative care teams incorporate other disciplines that often do the pre-visit prep (through a nurse, nurse practitioner, social worker or chaplain) and the post-visit follow ups.

Who qualifies for a palliative care consult?

Anyone with advanced chronic disease or unmet needs, despite engagement with the medical community. A few examples:

  • In the hospital setting:
    • A frail, elderly, hospitalized patient in the intensive care unit on the ventilator for three weeks with little sign of progress. Family is unsure what to do next
    • A cancer patient with uncontrolled pain and nausea
  • At home or in clinic:
    • A home-bound patient with dementia, stressed caregivers, and low back pain who has made multiple trips to the emergency room in the past few months. The family needs support and help with decision-making; the patient needs a better approach to pain management
    • A patient who lives at home alone and has ALS. She has lost weight and had more fatigue recently. She adamantly does not want to move to an inpatient facility. A feeding tube has been recommended but she is at a crossroads. Advanced care planning and symptom management are the main goals of the consult
  • In a skilled nursing facility:
    • A frail, elderly long-term care patient with dementia who has been slowly declining for months and probably does not have more than 6-12 months to live. The family lives far away but will be in town next week. Goal-setting and understanding of family preferences for end-of-life care are the main purpose of the consult

What is the typical follow-up for palliative care consults?

  • About 25-35% of consults are for a short term – or episodic – need and no follow-up is necessary. They are discharged from the palliative care service
  • About 25-35% of palliative care consults are actually eligible for hospice, and many are referred in that direction
  • About 25-35% of patients die during their engagement with a palliative care team